Pathology of the Liver 1

Question 1

What are the stages of pathogenesis for liver disease?

Answer 1

insult to hepatocytes
inflammation
fibrosis
cirrhosis

Question 2

What is the definition of acute liver failure?

Answer 2

acute onset of jaundice/ development of hepatic encephalopathy 2-3 weeks after the first symptoms of hepatic insufficiency

Question 3

Causes of acute liver failure

Answer 3

• viruses
• alcohol
• drugs (paracetamol overdose)
• bile duct obstruction

Question 4

What is jaundice?

Answer 4

yellowing of the skin due to the build up of bilirubin

Question 5

Pre hepatic jaundice occurs due to..

Answer 5

increased haemolysis, which means levels of unconjugated bilirubin are raised

Question 6

Causes of pre hepatic jaundice

Answer 6

haemolytic anaemia, haemolytic disease of the newborn, Gilbert’s syndrome

Question 7

What is Gilbert’s syndrome?

Answer 7

increased levels of unconjugated bilirubin, hereditary

Question 8

What is hepatic jaundice?

Answer 8

damage to hepatocytes, resulting in increased conjugated and un conjugated bilirubin

Question 9

causes of hepatic jaundice

Answer 9

alcoholic hepatitis
cirrhosis
pregnancy
bile duct loss

Question 10

what is post hepatic jaundice?

Answer 10

bile cannot pass into the bowel or biliary tree, so leaks into the circulation

Question 11

symptoms of post hepatic jaundice

Answer 11

dark urine, pale faeces

Question 12

what causes post hepatic jaundice?

Answer 12

gallstones of CBD
strictures of CBD, e.g due to surgery
congenital biliary tree atresia
tumours of the head of the pancreas

Question 13

what is Cirrhosis?

Answer 13

irreversible change to the liver, where bands of fibrosis separate the regenerative nodules of hepatocytes

Question 14

complications of cirrhosis

Answer 14

portal hypertension
spider naevi
ascites
LIVER FAILURE

Question 15

how to diagnose cirrhosis?

Answer 15

LFTs
Ultrasound
CT

Question 16

causes of cirrhosis

Answer 16

alcohol
hepatitis B/C
gallstones
Wilson's disease
autoimmune diseases

Question 17

Three types of portal hypertension

Answer 17

prehepatic - blockage of portal vein before the liver
hepatic - disruption/change of liver architecture
posthepatic - blockage in the venous system after the liver

Question 18

Complications of portal hypertension

Answer 18

oesophageal varices
ascites
splenomegaly
dilatation of anastomoses between systemic and portal system

Question 19

Alcoholic fatty liver features

Answer 19

occurs after a short binge
fat accumulates in hepatocytes
reversible

Question 20

alcoholic hepatitis features

Answer 20

occurs after weeks-months
inflammation
necrosis
pericellular fibrosis
mallory bodies
reversible

Question 21

alcoholic fibrosis features

Answer 21

months-years

collagen lay down around cells

Question 22

alcoholic cirrhosis features

Answer 22

irreversible

bands of fibrosis separate regenerative nodules

Question 23

What is non alcoholic fatty liver disease?

Answer 23

• build up of fat in hepatocytes, pathology is same as alcoholic liver disease

Question 24

Who gets NAFLD?

Answer 24

• occurs in individuals who do not drink alcohol
• obese
• diabetics
• hyperlipidaemia

Question 25

treatment and diagnosis of NAFLD

Answer 25

CT
LFTs
weight loss, lifestyle changes, diet changes

Question 26

what is non alcoholic steatohepatitis (NASH)?

Answer 26

hepatic fat accumulation alongside inflammation of the liver, which can ultimately cause hepatic necrosis

Question 27

how do you diagnose NASH?

Answer 27

liver biopsy

Question 28

What is chronic liver failure?

Answer 28

when the functional capacity of the liver cannot keep normal physiological conditions